Provider Demographics
NPI:1114532074
Name:BLISS PELVIC HEALTH
Entity Type:Organization
Organization Name:BLISS PELVIC HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DWAGNE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HASKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:813-993-4212
Mailing Address - Street 1:2640 CYPRESS RIDGE BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-6318
Mailing Address - Country:US
Mailing Address - Phone:813-993-4212
Mailing Address - Fax:
Practice Address - Street 1:2640 CYPRESS RIDGE BLVD STE 103
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-6318
Practice Address - Country:US
Practice Address - Phone:813-993-4212
Practice Address - Fax:813-738-1562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-08
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty